Embracing change: ‘Move health care forward’ with virtual care partnerships
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Health care involves managing two fundamental transitions simultaneously — the emergence of digital or virtual care and a slow shift to value-based care.
For many specialties, but especially gastroenterology, both involve the embrace of preventive and integrated multidisciplinary care. Data supports using a multidisciplinary approach — including diet, behavioral and lifestyle interventions — to improve patient outcomes. But there is a scarcity of these clinicians, as well as a much broader set of considerations, holding back the ability to evolve a specialty that is structured to primarily utilize sophisticated procedures for diagnosis and treatment.
As current and past leaders within the ACG and AGA, we speak with many GI practices that privately question how they will effectively survive long-term as a business in the face of these transitions. And for a specialty that is already under siege from a shortage of gastroenterologists, diminishing patient satisfaction and payer pressures, the optimal path forward brings together the best of both in-person and digital health care — complementing care that doctors can offer in their office with access to high-touch multidisciplinary specialists via telehealth.
We will achieve optimal patient care only with a collaboration among payers, local practices and virtual-first telemedicine clinics. We believe, if executed properly, hybrid collaborative care partnerships rooted in value-based care principles provide a roadmap to building a thriving, profitable practice.
Let us explore the considerations for local GI practices to benefit from forging partnerships with telemedicine companies offering innovative solutions to improve outcomes, increase access and optimize practice operations.
A solution for clinician shortages, insurance coverage
Like all specialties, gastroenterology is facing a great shortage of clinicians. Competition for newly trained gastroenterologists is high and worse in rural geographies. Meanwhile, new patients wait months for their first appointments while coping with debilitating symptoms.
When patients are eventually seen, physician time with them is limited, as are our available options. We may offer referrals to other specialized providers, such as a dietician or psychologist — clinicians who are also in short supply. When patients do have access to a GI psychologist or dietitian in their area, most will find that these visits are not covered by their insurance.
Every year, reimbursement rates get tighter, the work of prior authorizations gets greater and patients face more out-of-pocket fees. In the face of these challenging economics, telemedicine companies are increasingly contracting directly with insurers, allowing care to be delivered without burden to the patient or the practice.
Covered access to these specialized clinicians — delivered through collaborative platforms and the convenience of telemedicine — has the potential to significantly change patients’ engagement in their care journey and ultimate health outcomes.
Care coordinators on these telemedicine teams can also assume responsibility for ancillary services and call center support, even improving procedure preparation. Ultimately, this extension of the care team can optimize practice capacity for necessary in-person care.
Telemedicine convenient, expands access to care
Multidisciplinary care teams focus on solving the patients’ problems and getting to the root of their condition through the iterative process of dietary, behavioral and medication interventions. How the patient responds to these interventions can confirm the diagnosis and inform symptom control measures.
In practice, we frequently see patients struggling to interpret and sustain complicated exclusion diets, patients with nutritional deficiencies from restrictive diets and anxiety around foods. Telehealth enables support between in-person visits for multidisciplinary care, symptom tracking and care plan compliance and coordination, improving the patient experience while driving operational efficiency for local practices.
Telemedicine also has the potential to extend access to this care model beyond top academic medical centers, with the added benefit of convenience in the patient’s journey.
While all patients are likely to benefit from multidisciplinary care, the reality is that those feeling acute symptoms and the frustration of elusive answers about their dietary and emotional triggers are the most likely to engage in the iterative process of multidisciplinary hybrid care.
A pressure ‘release valve’ for practices
Hybrid collaborative care is the release valve to the pressures that practices face and their ability to care for their patients. We also believe these collaborative partnerships have the potential to vastly improve the clinician experience — optimizing the time spent with every patient and reducing the burden of patient phone calls, questions and care coordination.
The specifics of how comanaged patient care works can be determined between the practice and the telehealth team, but in general, virtual care platforms enable seamless collaboration and communication between local gastroenterologists and their virtual care team. Local gastroenterologists also gain enriched patient information shared by nutritionists and other specialists to continuously enhance treatment plans.
Long term, these partnerships have the potential to create a virtuous flywheel effect that empowers clinicians, increases the number of patients able to receive treatment, improves and measures outcomes and fuels payment innovation as virtual-first care providers take the lead in negotiating risk-bearing, value-based contracts at a national level.
Gastroenterology is a complex specialty. While we have seen the impact of virtual-first models in other specialties that require less human interaction, the pioneers of these hybrid care models requiring high in-person coordination will ultimately truly move health care forward, to the benefit of all stakeholders — practices, clinicians and patients.
For more information:
John Allen, MD, MBA, AGAF, is retired chief clinical officer at University of Michigan Medical Group and past president and chair of the AGA.
William D. Chey, MD, AGAF, FACG, is H. Marvin Pollard Professor of Gastroenterology and chief of gastroenterology and hepatology at Michigan Medicine. He also serves as treasurer of the ACG.
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